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Such new provision must move beyond a nine-to-five culture. Why in a 24-hour city is most healthcare only available for a third of the time? Twenty-first-century Londoners expect services to fit around their needs in a flexible way, but the NHS has remained in the 20th century in the levels of convenience and customer service that it provides. Studies have shown that, despite great improvements in healthcare, from 1983 to 2003 satisfaction with the NHS fell, as peoples expectations rose. For the pre-war generation the very existence of a health service offering care free at the point of need was a thing of wonder. Those who have always known an NHS rightly expect far more from it, and if the NHS is to maintain public support and last another 60 years, it has to meet these expectationsexpectations that include convenience. That means not always having to take time off work for doctors appointments. It means having more community-based and midwife-led services, which people told me they wanted to see in London. It means a big expansion of local urgent care facilities, not a closure of accident and emergency departments. Most of all, people expect to be treated as an individual with their particular personal needs met. So, instead of a one-size-fits-all health service, we need one tailored to the individuals needs, whether that is a child with asthma or a cancer patient at the end of their life.
Perhaps I may come back to the important point on workforce planning raised by the noble Baroness, Lady Emerton. I could not agree more. One of my recommendations to the health authority was not only to design the workforce, but to design it in a way that meets service needs.
To conclude, it is clear that inequality, outdated healthcare provision and public demands are three big challenges. But we can overcome those. I have offered some suggestions in my maiden speech as to how they can be addressed. I remind the House that I did this piece of work as a clinician and I am very much looking forward to my noble friend Lord Warner implementing some of the recommendations of the strategic framework.
I believe that NHS London, as the single strategic health authority for the capital, is ideally placed to take forward the recommendations in the Health Care for London report. It will take them forward with clinicians, managers, local authorities, other partners andmost important of allthe people of London. I believe that the result will be the world-class healthcare that Londoners deserve.
Earl Howe: My Lords, I congratulate the Minister on behalf of the whole House for a truly excellent and most authoritative maiden speech. To give a maiden speech from the government Dispatch Box is not everyones idea of a gentle baptism, but the noble Lord starts his parliamentary life with two associated advantages: first, the fact that he is without question master of his subject; and, secondly, the respect and good will with which he is regarded by noble Lords on all sides of the Chamber. I have already adverted to the Governments good fortune in having the noble Lord in their midst, but the good fortune is ours as well. While we are bound to appreciate the considerable calls on his time in the next few months at least, I believe, in the light of his speech today, that it is not wrong of me to express the hope that we may look forward to his addressing us on many more occasions in the future.
The noble Baroness said: My Lords, I shall speak also to Amendments Nos. 148 to 151. The amendments are intended to raise again the issue of whether all parishes should be given power to promote well-being. This matter was raised by the noble Baroness, Lady Hanham, at the previous stage. All the amendments delete the term eligible and the definition of an eligible authority or parish councileligible meaning a council that,
The Minister explained what was meant by eligibility and the purpose of these amendments is to seek further information on that. She explained that eligibility would be based on the non-statutory quality parish scheme. She said that it,
I want to ask her about two of those items and to make a general point. First, what is meant by proper accountability in this context? We have democratic elections. Is this something to do with the manner in which meetings are held? What scope is there for a parish not being properly accountable within the terms of its constitution? Secondly, I had not understood that the ethical framework was optional; therefore, where does it fit in as regards meeting the test of eligibility.
Can the Minister tell the House what is meant by exercising powers sensibly or, conversely, what would constitute non-sensically or non-sensibly or whatever? It sounds as though I am making light of this; I am not. I should like to understand whether the tests which are to be applied and which will be the basis of the Secretary of States direction are capable of objective assessment or whether they are tests that might be thought to be exercised subjectively. I beg to move.
The Parliamentary Under-Secretary of State, Department for Communities and Local Government (Baroness Andrews): My Lords, we had an interesting debate on this in Committee and went into some detail about notions of eligibility. The amendment has been brought back in a slightly different form, so I think it is worth reminding ourselves why we have attached conditions to this concept and why that is important.
The noble Baroness asked some good questions. Of the four tests, I think I am better prepared on the two that she did not ask about than on the two that she did, but I might get some assistance on the precise notion of the framework.
Essentially, the clause as drafted must be taken with paragraph 7 of Schedule 6, which releases eligible parish councils from the constraints of Section 137 of the Local Government Act 1972. That is the point. As noble Lords know, that provision limits parish councils discretionary spending to a small amount per local government electorcurrently £5.63. The amendment would deprive government of the power to set conditions which parish councils must meet before exercising the well-being power, for which there are very good reasons. The amendment does away with the concept of eligibility in the main clause, but I should advise the noble Baroness that it leaves it in the schedule, which I assume is an oversight.
When we discussed the clause in Committee, noble Lords knew that we were very much against the idea that every parish should automatically be able to exercise the power, together with an unlimited power to incur expenditure. We think it is much better to
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The noble Baroness asked me to define what is sensible. This is a new power and it involves parish councils being able to spend above their current limits. By sensible, we intend the ordinary meaning of the wordthat is, that councils should undertake things which, on the proper judgment of the council, are appropriate to be done and for which they are competent, that there should be a need for them and that they should not strain or overwhelm the councils resources. The local area should benefit from those things without disproportionate cost in terms of time and effort and without them overlapping with any of the things that other layers of local government could do. I do not know whether there is a better definition than that; there probably is but that seems to me to be the sort of approach that we are taking. So far as I know, sensible is not defined anywhere.
The conditions that we have imposed simply illustrate that, by introducing the clause, we are prepared to give parish councils the same broad powers as those enjoyed by principal authorities. However, the main difference is that principal authorities have professional support and legal advice. They are also subject to capping if their expenditure becomes unacceptably high. We need to think about that as the comparator when we consider the wisdom of the amendments.
I want to mention two of the conditions first. We have not coupled the well-being power with a proposal to take powers to cap parish council expenditure. We did not want to do that because we are content to rely on the sensibleness of parish councils. However, we also want them to be confident in what they are doing. We want them to have the sort of preparation and support equivalent to that which is available professionally to the other councils.
We do not think that the conditions will be onerous. As I said in Committee, it will be for a parish council itself to determine whether it is eligible and to defend that decision later if challenged, so there is nothing bureaucratic about this. The first of the two practical conditions will be that a good proportion of the councillors will have been elected rather than co-opted. We think that that will probably mean about two-thirds of the councillors being elected, but that will have to be confirmed after a wider consultation following Royal Assent. The second condition is that the councils, and especially their clerks, can certify that they have undertaken a modest piece of training or briefing, which we expect the sector to develop.
It is interesting that parish clerks are rapidly increasing in number and taking the CiLCA qualificationthe Certificate in Local Council Administration. About 1,000 have done so, and I understand that it takes about 40 hours of distance
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I turn to the two questions that the noble Baroness asked. In terms of the ethical framework, it is a fairly obvious application. The quality frameworkthe QPSensures that a parish is thoroughly applying the code of conduct to which it would, in any event, be committed. That is the objective standard.
I was asked what is meant by accountability. As I said before, we are not slavishly following the QPS, for the reasons that I explained. We are merely taking account of the conditions which establish competence and mandate. That is laid out in the QPS and would be a set of objective indicators as well. If the noble Baroness would like me to do so, I shall certainly send her that part of the QPS so that she can see what sort of elements go into it. I hope that I have answered the three questions sufficiently to reassure her.
In conclusion, it is very gratifying that the sector is very pleased with what we are doing and thinks that we have gone about it in the right way. It thinks the conditions that we have attached are sensible and wearable, and make for a reasonable and comfortable approach in terms of their competence and responsibilities. I hope that the noble Baroness will feel able to withdraw her amendment.
Baroness Hamwee: My Lords, I shall certainly ask leave to withdraw the amendment in a moment, but I should say that I remain a bit puzzled by the ethical framework. As the Minister says, they have to have it, so I do not understand how it can be part of a standard or test. That may become clear when I see how it is referred to in the QPS.
On how to ensure a democratic mandate, I wrote down, How could it not?, and the answer came back, Because there might be too many co-opted councillors. What about appointed councillors? Maybe that will figure in the final form of the scheme. It still sounds a bit subjective, but I think that I have made the point and I am grateful for the further information that this has elicitednot to suggest that it would not have been forthcoming. I beg leave to withdraw the amendment.
The noble Lord said: My Lords, in moving Amendment No. 163A, I shall also speak to Amendment No. 163B. They are about a situation that could occurprobably not very oftenwhen the recommendations of what we now call a parish review, which will in future be called a community governance review, recommends the abolition of a parish council. That refers to the second amendment.
The first amendment refers to when the parish review proposes that a parish is too small to have a parish council. My amendment would allow a parish council to be created in appropriate circumstances even if the number of electors was below 150.
We discussed both these issues in Committee in a rather different form, when some of us expressed concern that the Governments proposal would make it more restrictive when community governance reviews have taken place, so that the thresholds on where there can be or has to be a parish council are significantly raised. I have accepted the Governments views on the middle range, where the level at which there has to be a parish council is raised significantly. I do not agree with it but understand that it is a matter for local discussion. There are a number of instances of existing parishes with very active parish councils that in future would be unable to have a council. That is against the philosophy of devolution of allowing appropriate local activities.
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